Compliance Analyst III


Website Administrative

Reference Code: 4910

Position Title: Compliance Analyst III
Location: Irving, TX, 75014 ( The position will start remote and could transition into the office, though this is negotiable)
Duration: 4/5/2021 – 10/4/2021 with possible extension

***This candidate must have Compliance or Government Programs experience in a Health Plan setting. Non-negotiable***

Candidates MUST be located within Texas. The position will start remote and could transition into the office, though this is negotiable.

o Act as centralized point of contact/designee for operational compliance as a result of state Medicaid contract or other regulatory updates that need to be implemented.
o Regularly communicate with Health Plan’s Government Contracts and Compliance teams for regulatory updates and external audits.
o Act as lead with researching new regulatory requirements and other updates that may be of impact to Health Plan Operations. Translate regulatory requirements into actionable business requirements for implementation
o Attend state meetings as assigned
o Work along-side the Health Plan Operations Leadership to track, monitor and respond to deliverables due to externally to regulators—both scheduled and adhoc in nature.
o Help manage project related work for Health Plan Operations—i.e. those items identified to drive operational compliance
– Process Improvement strategies
– Update documentation – P&Ps, desk aids, etc.
o Support Health Plan Operations Leadership in meeting defined milestones for critical projects, including both internal and external in nature (i.e. state implementations)
o Host calls with health plan executives and other staff as appropriate

o 5+ years’ experience in Managed Care, Healthcare Compliance, and/or Health Plan Operations
o Must be a self-starter—ability to move forward with limited direction
o Experience writing and reviewing requirements documents
o Experience researching state requirements
o Experience managing high-profile/highly visible Health Plan related projects
o Experience with vendor management
o Experience with Internal Audit/Risk Management
o Keen eye for detail and the ability to be well-organized
o Critical thinking and execution (ability to be proactive)
o Intermediate to advanced Microsoft Word, Excel, PowerPoint, Project, Visio
o Experience with SharePoint or other shared site concepts
o Ability to communicate well, both orally and written (includes note-taking and documentation)
o Advanced presentation skills

Schedule: 8AM – 5PM CST with overtime as needed.
Potential to convert to perm.


· The Compliance Analyst is primarily dedicated to the development of the Compliance program to support all new lines of business.

· The Analyst will serve as the Compliance subject matter expert in the proposed new lines of business and will provide leadership to support the Compliance Director and Compliance Program to ensure business integrity and Compliance with all Federal and State laws and regulations, contract provisions, accreditation standards, and internal policies/procedures to support growth of the organization.

· The Analyst will implement system wide initiatives, policies and processes related to the expansion efforts and be responsible for program oversight, risk assessment, creating reports, education/training and audit/monitoring.

· The Compliance Analyst will also support the Compliance Director in developing the Vendor Oversight Program to include analyzing risk assessments, performing audits, creating reports, educating and following up with the business area to ensure processes exist to demonstrate compliance with delegation and vendor oversight requirements for the Plan.

· The Analyst will serve as a resource to support the Compliance Director in the general development of the Compliance Program including, but not limited to, developing the Compliance Work Plan, Fraud, Waste and Abuse Plan, Compliance Committee, Board reports and Compliance policies and will also serve in an acting role to provide back up when the Compliance Director is not available.


Essential Functions:


· Provide oversight and direction in the development of all aspects of the Compliance Program and all future expansion initiatives.

· Develop and implement the Vendor Oversight Program to ensure Compliance with all regulatory requirements for the Plans oversight of delegated functions including, but not limited to first tier, downstream and related entities.

· Develop audit tools, plan, schedule, and conduct readiness audits as it relates to all new lines of business.

· Provide written reports of audit and Vendor Oversight findings, present recommendations to the Compliance Director and Compliance committee.

· Develop and implement Risk Assessment tool to identify potential deficiencies and facilitate development, monitoring and implementation of corrective action plans.

· Serve as the Compliance subject matter expert to internal and external stakeholders.

· Serve as the Compliance subject matter expert and liaison for Vendor Oversight activities.

· Escalate any issues of non-compliance immediately as necessary.

· Serve as the Compliance liaison with Government Contracts to receive any State or Federal correspondence or alerts on new initiatives.

· Support Compliance Director and serve in an acting role to provide leadership to the Compliance Department in the absence of the Director.



· Ability to effectively present information and respond to inquiries from employees, management, and others, as necessary.

· Ability to handle complex project planning/program issues and develop and implement policies and procedures.

· Excellent organization, problem solving and analytical skills.

· Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.

· Excellent report writing and presentation skills.

· Ability to work independently and set priorities.

· Strong orientation to deadlines and details with ability to meet competing deadlines.

· Ability to work and communicate effectively with employees at all levels of the organization.

· Decisive and exercises good judgment under pressure.

· Excellent interpersonal and verbal and written communication skills.

· Ability to abide by policies.

· Ability to maintain attendance to support required quality and quantity of work.

· Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).

· Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.


Required Education: Bachelor Degree or equivalent work experience.

Required Experience: 5-7 years of relevant experience.

Prior Compliance program management experience.

Knowledge of managed care contractual and regulatory requirements for Medicaid and Medicare. Advanced skills with MS Office tools (including Excel, Word, Power Point), Outlook and experience with auditing software.



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